Am J Psychiatry 1993; 150:1000-1010
Copyright © 1993 by American Psychiatric Association
The Vietnam War and the ethics of combat psychiatry
NM Camp
Department of Psychiatry, Medical College of Virginia, Richmond.
It has been two decades since American troops were withdrawn from Vietnam,
yet there has been little interest in resolving challenges that arose
during the war regarding the ethical justification for military
psychiatry's principles and field techniques for treating combat-generated
casualties. Recently, thousands of American service persons were sent to
fight in the Middle East accompanied by psychiatrists trained to use the
same military treatment doctrine. In the wars before Vietnam, this doctrine
had proved to be highly effective for treating individuals with combat
stress casualties and returning them to duty. Furthermore, it was
uncontroversial and later successfully adapted for use with civilian
populations. During the Vietnam war, however, many psychiatrists intensely
opposed a treatment regimen designed to induce symptomatic soldiers to
believe that facing further combat risks would be in their best interest or
that of the nation. As this review of the doctrine's rationale and ethical
quandaries suggests, combat psychiatrists are influenced by powerful,
potentially competing values systems but cannot realistically assess some
of the most important factors that affect the balance of harm and benefit
associated with their treatment decisions. This latest armed conflict
reminds us of critical moral and ethical questions regarding the divided
loyalties of combat psychiatrists--questions that should be addressed
through future research and formalized professional guidelines.
